Review Article

Prevention, Diagnosis and Management of COVID-19 in the IBD Patient

Aysha H. Al-Ani; Ralley E. Prentice; Clarissa A. Rentsch; Doug Johnson; Zaid Ardalan; Neel Heerasing; Mayur Garg; Sian Campbell; Joe Sasadeusz; Finlay A. Macrae; Siew C. Ng; David T. Rubin; Britt Christensen

Disclosures

Aliment Pharmacol Ther. 2020;52(1):54-72. 

In This Article

Abstract and Introduction

Abstract

Background: The current COVID-19 pandemic, caused by SARS-CoV-2, has emerged as a public health emergency. All nations are seriously challenged as the virus spreads rapidly across the globe with no regard for borders. The primary management of IBD involves treating uncontrolled inflammation with most patients requiring immune-based therapies. However, these therapies may weaken the immune system and potentially place IBD patients at increased risk of infections and infectious complications including those from COVID-19.

Aim: To summarise the scale of the COVID-19 pandemic, review unique concerns regarding IBD management and infection risk during the pandemic and assess COVID-19 management options and drug interactions in the IBD population.

Methods: A literature review on IBD, SARS-CoV-2 and COVID-19 was undertaken and relevant literature was summarised and critically examined.

Results: IBD patients do not appear to be more susceptible to SARS-CoV-2 infection and there is no evidence of an association between IBD therapies and increased risk of COVID-19. IBD medication adherence should be encouraged to prevent disease flare but where possible high-dose systemic corticosteroids should be avoided. Patients should exercise social distancing, optimise co-morbidities and be up to date with influenza and pneumococcal vaccines. If a patient develops COVID-19, immune suppressing medications should be withheld until infection resolution and if trial medications for COVID-19 are being considered, potential drug interactions should be checked.

Conclusions: IBD patient management presents a challenge in the current COVID-19 pandemic. The primary focus should remain on keeping bowel inflammation controlled and encouraging medication adherence.

Introduction

In December 2019, reports of a novel coronavirus, since named SARS-CoV-2, emerged from Wuhan, central Hubei Province, China.[1–3] The virus causes the disease COVID-19, which manifests as a severe acute respiratory illness that can be complicated by acute respiratory distress syndrome (ARDS), multiorgan failure and even death.[3] Following rapid spread of the virus across the globe, the World Health Organisation (WHO) declared COVID-19 a pandemic on 11 March 2020.[2] There are currently almost 2 million confirmed cases across more than 200 countries with a total death count greater than 100 000 at the time of writing.[2] As the pandemic expands, there has been increasing concern regarding the impact of COVID-19 on patients with IBD.

The primary management of IBD involves treating uncontrolled inflammation with a significant number of patients requiring immune-based therapies.[4] In the last decade, there has been a considerable expansion of the therapeutic armamentarium for patients with IBD to include immunomodulators, TNF antagonists, non-TNF-targeted biologics and targeted small molecule therapies.[5] However, these therapies, in addition to malnutrition which can complicate IBD, may weaken the immune system and potentially place IBD patients at increased risk of infections and infectious complications.[6]

Consequently, there is a concern that IBD patients are at greater risk of developing COVID-19 and at increased risk of progressing to a more severe clinical course or even death compared to the general population. In addition, if an IBD patient develops COVID-19, there is a lack of guidance on medication management and concern regarding drug interactions if trial medications are utilised to treat COVID-19.

Therefore the aim of this review is to summarise the evidence and discuss in detail the data regarding the risks of developing COVID-19, strategies that can be implemented to reduce these risks and issues surrounding the treatment of COVID-19, including potential drug interactions and IBD medication management, in the IBD patient cohort.

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